England's HIV services face complex new environment

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On April 1, 2013, a major transition in health care began in England through the Health and Social Care Act. The reform included the abolishment of National Health Service (NHS) primary care trusts (PCTs), which oversaw services at a regional level, with their local commissioning powers transferred to the 220 groups of general practitioners, called clinical commissioning groups (CCGs). Sexual health services and HIV prevention (including HIV testing) was also transferred to the control of England’s 353 local authorities (councils), who now find themselves negotiating directly with NHS and other providers to continue these services. One of the potential problems of this break-up of HIV care from prevention is that sexual health or genitourinary medicine (GUM) is usually delivered in the same buildings and by the same teams as HIV care, and experts at both the British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH) have raised concerns that the split will mean services that have taken years to develop could rapidly disintegrate, leading to deteriorating patient care, services, and staff training, while jobs and crucial in-house experience could be lost. “The previous UK Government under Tony Blair allowed PCTs to tender for services if they wanted to, but most preferred to keep services in-house”, says Janet Wilson, president of BASHH. “Those that did tender ran into problems, sometimes serious problems, and we are worried there will be more examples of damage to patient care as more local authorities put their sexual health services out to tender.” Observers think that most local authorities will tender for their sexual health and HIV prevention services in the next 2-3 years. “Sexual health clinicians have been sounding warnings about the restructuring of sexual health since the full details of the government’s health reforms became clear. Fragmentation of sexual health services, particularly the split in commissioning of GUM and HIV, was highlighted as an area of great concern for patient care and public